Salvage Title Application Packet - IN.gov

1 STATE OF INDIANA Eric J. Holcomb, Governor Peter L. Lacy, Commissioner Salvage MOTOR VEHICLE Title Application Checklist A Salvage Title is required for motor vehicles manufactured within the last seven model years that have been wrecked or damaged. When requested, a Salvage Title may be issued for a vehicle over seven model years old. Salvage Title applications are processed by BMV Central Office. Prior to submitting each Application , verify all required information is included. Contact (888) 692-6841 with any questions. When submitting paperwork, include the following: Application for Certificate of Title for a Vehicle State Form 205 Salvage Title Affidavit - State Form 49891 Certificate of t itle oIf the certificate of Title is issued by a state other than Indiana, a completed Physical Inspection ofa Vehicle or Watercraft State Form 39530 must be provided.

2 Proof of the date of settlement provided by the insurance company (if owner of the Salvage vehicle is retaining possession of the Salvage vehicle) Submit payment for the following vehicle Title Application fees and taxes. Payable by MasterCard or Visa, check, electronic check, or money order. $4 Salvage Title Application fee. $10 additional administrative penalty will be assessed on a Title Application Packet received 45 days after the purchase date. If the owner of the Salvage vehicle retains possession of the Salvage vehicle, the owner must apply for a certificate of Salvage Title not later than 45 days after the settlement of loss with the insurance company. $25 speed Title fee. This optional fee is in addition to the $4 Salvage Title Application fee. Paying the optional speed Title fee ensures that the Title is processed in a period of time that is substantially shorter than the normal processing period.

3 If Salvage vehicle is transferring ownership, include 7% sales tax of the purchase price or provide proof of sales tax paid on an ST108- Certificate of Gross Retail or Use Tax Paid State Form 48842. If ownership is being maintained, or if exempt from sales tax, include an ST108E Certificate of Gross Retail or Use Tax Exemption State Form 44841. Vehicle color: _____ (List color on line) For your convenience, the required forms are included with this checklist. The forms are also available at Mail the completed Packet to: Indiana Bureau of Motor Vehicles Central Office Title Processing 100 North Senate Avenue, Room N411 Indianapolis, IN 46204 If the BMV determines that sufficient credible evidence exists to substantiate the applicant s claim of ownership, a Title will be issued. If all required documents are not submitted or information is incomplete, the entire Application will be returned.

4 Please include this checklist with your Application . Application FOR CERTIFICATE OF Title FOR A VEHICLE State Form 205 (R10 / 11-18) INDIANA BUREAU OF MOTOR VEHICLES *This agency is requesting disclosure of your Social Security Number / Federal Identification Number in accordance with IC 4-1-8-1; disclosure is mandatory, and this record cannot be processed without it. To be completed by a police officer, BMV official, or BMV certified dealer signee for out-of-state titles. I hereby certify that I personally examined the following vehicle and find the identification number to be as follows. I swear or affirm that I am authorized to perform this transaction, and I agree to indemnify and hold harmless the Indiana BMV from any and all liability arising from this transaction. I swear or affirm that the information that I have entered on this form is correct.

5 I understand that making a false statement on this form may constitute the crime of perjury. Applicant Signature: _____ Printed Name: _____ Applicant Signature: _____ Printed Name: _____ Date (mm/dd/yyyy): _____ Vehicle Identification Number Year Make Model Type Date (mm/dd/yyyy) Inspector s Printed Name and Title City Inspector s Signature Badge, Branch, or Dealer Plate Number Transaction Number Branch Number Invoice Number BMV Use Only Social Security Number / Federal Identification Number * Name of Applicant BMV Use Only Residence Address (number and street) City State ZIP Code Vehicle Identification Number Vehicle Year Vehicle Make Vehicle Model Vehicle Type Odometer Former Title Number Purchase Date (mm/dd/yy) Lien (Y/N) Speed (Y/N) Dealer Number BMV Use Only ELT ID Holder of First Lien, Mortgage, or Other Encumbrance / Special Mailing Address Mailing Address (number and street) City State ZIP Code BMV Use Only ELT ID Holder of Second Lien, Mortgage, or Other Encumbrance Mailing Address (number and street)

6 City State ZIP Code License Number License Year Forms Used BMV Use Only Gross Retail and Use Tax Affidavit I/We hereby certify that sales or use tax on this vehicle was paid as indicated below. Selling Price $ Less Trade-In / Discount $ Amount Subject to Tax $ Amount of Tax $ Dealer Branch Exempt Exemption Code Salvage Title AFFIDAVIT State Form 49891 (R3 / 2-19) INDIANA BUREAU OF MOTOR VEHICLES INSTRUCTIONS: 1. Complete in blue or black ink or print form. 2. A certificate of Salvage Title is required for a motor vehicle, motorcycle, semitrailer, pursuant to the requirements as outlined inIndiana Code 1 - OWNER INFORMATION Owner Name(s) (last, first, middle initial or company name) Legal Address (number and street) City State ZIP Code SECTION 2 INSURANCE COMPANY INFORMATION (if applicable) Company Name Agent Name Address (number and street) City State ZIP Code SECTION 3 - VEHICLE INFORMATION Vehicle Identification Number Vehicle Year Vehicle Make Vehicle Model Date of Settlement (mm/dd/yyyy) Reason SECTION 4 AFFIRMATION STATEMENT I hereby request the Indiana Bureau of Motor Vehicles to issue a Salvage Title for the above mentioned vehicle.

7 I certify that the vehicle meets the Salvage Title requirements of Indiana Code 9-22-3. I swear or affirm that the information I have entered on this form is true and correct. I understand that making a false statement may constitute the crime of perjury. I agree to indemnify and hold harmless the Indiana Bureau of Motor Vehicles from any liability arising from this transaction. Signature of Owner Printed Name Date Signed (mm/dd/yyyy) PHYSICAL INSPECTION OF A VEHICLE OR WATERCRAFT State Form 39530 (R8 / 6-21) INDIANA BUREAU OF MOTOR VEHICLES INSTRUCTIONS: 1. Approved inspector must complete information in blue or black ink or print form. 2. The vehicle identification number (VIN) or hull identification number (HIN) must be inspected to verify the existence and condition of the number. An ownership document is not required to be submitted for inspection.

8 3. Inspections may be performed by an employee of a dealer licensed under IC 9-32, a military policeman assigned to a military post in Indiana, a police officer, a designated employee of the BMV, an employee of a qualified person operating under a contract with the commission, or an employee of a dealer that is licensed as a motor vehicle dealer in a state other than Indiana and approved by the bureau. 4. Police officers completing this form may charge a fee of not more than $ for this inspection under IC 9-17-2-12. OWNER INFORMATION Name (last, first, middle initial or company name) Address (number and street) City State ZIP Code VEHICLE OR WATERCRAFT INFORMATION Identification Number NONE (Select if no identification number found.) Year Make Model Type Plate Number / State Watercraft Registration Number, if applicable For assembled vehicles or watercraft include serial numbers for major component parts if present: Engine / Motor Transmission Body Chassis Front Assembly Rear Clip Frame Other (specify): *IDACS / NCIC Check (Required if form is completed by a police officer) Date Check Performed (mm/dd/yyyy) Comments I swear or affirm that the information I have entered on this form is correct.

9 I understand making a false statement may constitute the crime of perjury. Signature of Inspector Printed Name Title Date (mm/dd/yyyy) Badge/ Branch/ Dealer Number Police Department / Branch / Dealership City State ZIP Code Telephone Number ( ) E-mail BUREAU OF MOTOR VEHICLES 100 N. Senate Avenue, Room N440 Indianapolis, IN 46204 (888) 692-6841 COLLECTION OF PAYMENT INFORMATION State Form 56163 (R / 9-18) INDIANA BUREAU OF MOTOR VEHICLES BUREAU OF MOTOR VEHICLES Central Office Finance 100 N. Senate Avenue, Room N440 Indianapolis, IN 46204 (888) 692-6841 INSTRUCTIONS: 1. Complete in blue or black ink, or print form. 2. Enter the amount to be charged and the payment type information in Section 2. Payment may be made by Visa, MasterCard, Discover, American Express, or electronic check. If enclosing a check, money order, cashier s check, or certified check, this form is not required.

10 3. Mail this form to the address that is specified on the Application being submitted and for which you are making payment. 4. This form will be destroyed immediately after payment has been processed. SECTION 1 - ACCOUNT HOLDER INFORMATION Name of Account Holder (first, middle, last, or company name) Driver s License Number (DLN) or Federal Identification Number Telephone Number Billing Address (number and street) City State ZIP Code SECTION 2 - PAYMENT INFORMATION Amount to be Charged: $ _____. _____ Description of the service/ Application to which the payment is related: CREDIT CARD PAYMENT Type of Credit Card: Visa MasterCard Discover American Express Credit Card Number: _____ - _____ - _____ - _____ Expiration Date (mm/yy): _____ / _____ Electronic Check Payment Routing Number: Account Number: SECTION 4 - AFFIRMATION STATEMENT I hereby authorize the Indiana Bureau of Motor Vehicles to charge the account indicated above.